Diabetes

Dr. Anurag Shahi (AIIMS)MBBS,MD

January 21, 2017

January 29, 2024

Diabetes
Diabetes

Summary

Diabetes is a common endocrine disorder, that can affect people of any age or gender. Diabetes in medical terminology is known as Diabetes mellitus, It is identified by the presence of high blood glucose (sugar) levels in the bloodstream. Diabetes can be categorized into Type 1 Diabetes and Type 2 Diabetes mainly. The other categories are juvenile diabetes, gestational diabetes, and prediabetes.

Please check this page for complete diabetes treatment.

Medical researchers are trying to find a complete diabetes treatment because diabetes is often associated with serious complications and comorbid health conditions such as blindness, cardiovascular diseases, amputations, etc especially when this condition is not managed properly. However, it has been observed that alterations in lifestyle, diet, medicines, exercises and certain therapies can help people arrest the disease at an early stage and effectively manage diabetes.

In this article, you will learn about diabetes symptoms, causes, and treatment.

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Types of Diabetes

There exist different types of diabetes, but to begin with, we will first explain the 3 main types which are prediabetes, type 1 diabetes, and type 2 diabetes. After that, we will discuss diabetes causes, diabetes symptoms, and diabetes treatment

Prediabetes

This indicator type is often referred to as “Borderline diabetes" too. It is identified by a doctor when one has higher than normal blood sugar levels after fasting, along with higher than normal blood sugar levels after eating. Research strongly recommends that prediabetics can prevent or delay the onset of Type 2 diabetes by taking necessary measures such as following diabetic diets, cutting down on carbohydrates, refined sugar, processed foods, and bakery items, adopting a healthy lifestyle, engaging in physical activities such as swimming, jogging, gymming, cycling and 45 minutes of brisk walking to begin with.

Type 1 Diabetes

Type 1 diabetes is insulin-dependent diabetes, often detected in children and people under 30 and it is believed to contribute to 10 percent of the world's diabetes population. This condition mainly arises when the human body produces minimal or no insulin at all because of damaged pancreatic beta cells. Due to this glucose is not stored and cannot be utilized in the form of energy, which leads to excessive accumulation of glucose (sugar) in the bloodstream.
Type 1 diabetes has two further subtypes:

  • Juvenile Diabetes: Type 1 diabetes also includes Juvenile diabetes which is Insulin-dependent (a lifelong condition) occurring in children under 19. Administration of Insulin injections to small children is typically supervised by parents, caregivers, and nurses. Diabetics in their teens can also self-administer insulin shots as recommended by their doctors.  
  • LADA: Type 1 also includes a special category of people with diabetes who have Type 2 but they mimic conditions of type 1 due to faulty or no insulin secretions from the beta cells of the pancreas called LADA (Latent Autoimmune Diabetes Adulthood).

Type 2 Diabetes

Research suggests Type 2 diabetes to be the most common and predominant, this condition arises typically when the body produces less than the required amount of insulin, or the body is unable to use the insulin produced due to a phenomenon called insulin sensitivity. Due to this malfunction, an excess amount of glucose (sugar) builds up in the body resulting in high blood sugar levels. Type 2 diabetes usually affects people over 30 but significant studies hint that it can occur in young children too. Type 2 is often genetic and it may be passed on from one generation to the other. Growing cases of Type 2 diabetes globally holds an unhealthy lifestyle, zero or less physical activity, stress, and faulty eating responsible for the onset of diabetes.

Gestational Diabetes

As the name suggests this condition develops during pregnancy, studies claim that the mother usually acquires it around the later stages of pregnancy and has high blood glucose (sugar) levels. It has been observed that the condition disappears soon after the delivery of the child. But having said this, it does not mean that this can be taken usually. Gestational diabetes may cause complications for the mother and the child if this condition is not detected and managed effectively. You are highly recommended not to take any medicines on your own and seek your doctor's advice to take necessary precautions and actions.

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Diabetes Symptoms

Diabetes symptoms can be quickly identified if you are attentive to certain body signals. And the good news is upon early detection it can be treated and managed the diabetes symptoms. So, inform your doctor if you experience the following diabetes symptoms -

  • sudden hunger pangs (urge to eat).
  • feel the need to frequently urinate more than usual, especially during the night.
  • feel thirsty all the time.
  • notice sudden unexplained weight loss.
  • distorted, blurry vision, or double vision
  • begin to feel tired and fatigued easily.
  • have recurrent infections, especially of the gums, skin, and bladder.
  • wounds and cuts take more than usual time to heal.
  • mood swings and irritability.
  • tingling or burning sensations, especially in your feet and palms.
  • men may experience sexual dysfunction like erection dysfunction.

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When to see a doctor

It is recommended to immediately visit a diabetologist/ endocrinologist if you observe the following symptom along with high blood glucose (sugar) levels:

  • blood reports show constant high blood sugar levels (more than 300 mg/dl).
  • sudden loss of vision or blurriness in one eye or both eyes.
  • wounds don't heal and instead worsen in spite of the application of topical medications (creams and antiseptics) for more than 5 days.
  • high blood sugar levels during your pregnancy.
  • sudden loss of feeling particularly in the palms and feet area.
  • sudden pain and swelling in the arms, jaws, chest, and ankles.
  • severe skin infections along with pigmentation (skin discoloration).

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Diabetes Causes and Risk Factors

The exact diabetes causes cannot be ascertained and may vary from person to person. However, researchers hint that genetics, a sedentary lifestyle, faulty eating habits, autoimmune conditions, certain medications, and obesity are the most predominant reasons for the widespread of this disease.

Our pancreas (digestive system organ) produces an important hormone called insulin, which helps our body to utilize glucose (sugar) derived from the food we eat. When our body is unable to break down, store or utilize the glucose, it stays and results in high levels of glucose (sugar) in the bloodstream. Diabetologists recommend that blood glucose levels should be maintained between 70 mg/dl - 110 mg/dl ideally. Any readings above and beyond this should be reported to the doctor and further medically investigated.

The doctor may ask you to take certain tests to check for diabetes. The tests are performed to basically check for blood glucose levels while you are fasting, levels after you have eaten a meal, and blood glucose levels after drinking highly concentrated sugar mix drinks often containing glucose. The following are done to assess the body's ability to process glucose. The mentioned tests will give a clear picture to you and to your doctor to confirm whether you have diabetes or not. Additionally, your doctor will also guide you and help you identify the type of diabetes you are living with.

Risk Factors 

As mentioned above, the exact diabetes cause is not known, but there are several factors that may increase the likelihood of developing the disease. Some of these risk factors are -

  • Unhealthy diet
  • A family history of diabetes
  • Sedentary lifestyle
  • Being overweight
  • Pregnancy
  • Age
  • Certain medicines
  • Abnormally high cholesterol levels

Note that having any, or even all, of these risk factors does not mean you will necessarily develop diabetes.

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Diabetes Diagnosis

The doctor will diagnose any type of diabetes with the help of diabetes symptoms and blood samples drawn from you such as Type 1 diabetes, Type 2 diabetes, Prediabetes, Gestational, Juvenile, and LADA.

You are recommended not to self-diagnose diabetes symptoms or with medical instruments available in the chemist shops. This is because there can be high chances of errors and fluctuations in the detection of high blood glucose levels in the blood. You are urged to take professional help when in doubt hence, go by the doctor's recommendations and get the following essential tests done.

Fasting Blood Sugar

This is an initial test that's done to determine if someone has high blood sugar. It is done in the morning, in a state of fasting - that is, not eating anything for at least 9-12 hours. You are not supposed to even drink water until after the test is done.
A value less than 99 mg/dl is found to fall into the category of normal, and values above 100-120 mg/dl fall under the Prediabetes category. Values more than 126 mg/dl are said to be in the diabetic category.

Random Plasma Glucose

A random plasma glucose test is done when the doctor wants to investigate blood sugar levels immediately and randomly to check for any rise in the sugar levels after eating meals. There is no requirement to be empty stomach or fasting you can give samples for this test at any time. Any value above 200 mg/dl indicates diabetes.

Postprandial Blood Glucose Test

This test is specifically done when the doctor wants to know exactly how much are the sugar levels after eating a meal. This test is done exactly 2 hours from the start of eating a meal. In this particular test body's natural adjustment of blood sugar levels after a meal is assessed. The levels can usually spike (raise) or become very low either following which the doctor decides certain specific medicines be given.

The HbA1C test

The HbA1C test has really made a major difference in the diagnosis and treatment of diabetes. This test effectively calculates the average blood sugar levels for 3 months (90 days). You can eat and give your blood sample for testing no need for fasting. Spikes and lows in sugar levels will be calculated on an average of 90 days in percentage which will determine whether you are diabetic or not. However, certain parameters such as age, sex, race, and certain medical conditions are taken into consideration by the doctor before investigating diabetes basis HbA1C tests. Research hints that people suffering from anemia often produce incorrect HbA1C results. The results (in percentage) ranging between 1 and 5.7% indicate normal blood sugar levels. The results ranging from 5.8 to 6.4% are placed under the prediabetes category (people who are likely to get diabetes). And results above 6.4 fall into the diabetes category and often represent poor blood sugar level control.

Please note that the values given above are for awareness and patient information only. The test result ranges may vary from one laboratory to the other. You may also choose to repeat certain tests to confirm the values. You are highly recommended to confirm diabetes from a medical practitioner before starting any therapy or taking any medicines.

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How to control diabetes

Diabetes treatment is often misunderstood as painstaking and challenging because diabetes is a long-term condition. But on the contrary, the truth is, that we can overcome this condition by following the right ways to approach it. Let's check about the diabetes treatment

Variation in treatment

Diabetes treatment will not be the same for everyone it will differ from person to person depending on the type of diabetes the person is living with. For example, Type 1, Type 2, and gestational.

Seek treatment right away

As diabetes is a chronic progressive disease hence medicinal therapy should begin as soon as possible. It's a myth that one should not begin with medicines because it increases complications. On the contrary, the truth is doctors suggest that the sooner medicines begin higher the chances of arresting this condition and avoiding diabetes-related risks and complications.

Medicinal compliance

This term simply means that taking medicines daily, in the right amount, and at the correct times brings a huge difference in managing diabetes. When diabetes medicines are taken without following the correct timings and dosage then it does not help in managing diabetes at all and further leads to the spiking of blood sugar levels or hypoglycemic events (sudden drop in blood sugar levels).

Diet modification

Eating frequent small meals (6 meals) along with low sugar, low carbs, and high fiber diet is as important as ‘breathing oxygen” in diabetes management.

Physical activity

Research strongly hints diabetes may progress due to inactive and sedentary lifestyles. Hence adopting activities such as swimming, jogging, cycling, yoga, and gymming have proven to help control blood sugar levels to a great extent.

Type 1 diabetes treatment

Type 1 diabetes treatment is a disciplined process in which blood glucose levels are typically monitored at different time intervals (ideally a chart is prepared). Depending on the reading Insulin is injected multiple times as required. Additionally, a controlled diet and exercise regimes are to be particularly followed to manage Type 1 diabetes. Since Type 1 diabetes is mostly found in children and teenagers also (known as Juvenile diabetes) the doctors strongly suggest parents, caregivers, and nurses learn “How to inject” carefully and less painfully to ensure proper treatment and less scarring of the injection site in children. That's why type 1 diabetes treatment should be under the supervision of a doctor.

Type 2 diabetes treatment

People with Type 2 diabetes are often recommended to control blood sugar levels via diet modifications, exercises, and oral medicines. It has been observed that upon a doctor's recommendation people with type 2 may also require insulin injections as the disease progresses further. Hence upon early detection of type 2 diabetes, one must actively make efforts and change eating habits, adopt physical activities such as jogging, cycling, and swimming and check blood glucose levels at regular time intervals to ensure that the disease is arrested and does not progress further. Do not do type 2 diabetes treatment without consulting a doctor.

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Myths - what to eat & lifestyle tips for diabetics

Top 5 myths related to diabetes and foods

Eat a lot of small frequent meals but eat smartly read on to find out. Let's bust common myths surrounding “eating habits’’ and what to eat while living with diabetes.

Myth 1: Stop carbohydrates completely.

Fact: By stopping carbohydrates completely we make our body's system weak and susceptible to tiredness and fatigue. In fact, eating high- fiber low carbs such as oatmeal, brown rice, whole wheat bread, multi-grains, chia seeds, flax seeds, semolina, and puffed rice will not only power you with energy but also keep you away from constipation. You are recommended to manage portion sizes as per your daily physical activity.

Myth 2: Stop having sweets forever!

Fact: You can have sweets (small serving) once in a while provided you have managed your blood sugar levels well. For your sweet cravings, natural sugars “fructose’’ found in fruits can be a good replacement for sweets and bakery products made out of refined sugars. But you are highly recommended to maintain portion sizes as certain fruits have a very high glycemic index (sugar content). Do check blood glucose levels before indulging in sweets.

Myth 3: Eat 3 large meals only

Fact: Leading endocrinologists suggest eating small meals frequently, in time intervals to better manage your blood sugar levels effectively. Nutritionists split 3 large meals into 6 mini meals so that u don't feel hungry and also manage diabetes well.

Myth 4: Eat only salads diabetes will be controlled faster

Fact: Eating a balanced meal is very important to achieve good control of blood sugar levels. Experts recommend the famous “Eat by the plate method’’ which clearly states that your plate should be half filled with salads and fruits and one-fourth filled with low-fat proteins such as tofu, chicken, fish, cottage cheese, grams, pulses and left one fourth filled with low carbs such multigrain bread, chapattis, brown and puffed rice, etc.

Myth 5: If you are taking medicines you can have anything you like

Fact: The truth is diabetes management comes from disciplined eating. Medicines only help to store, and utilize glucose and flush out toxins. You are urged not to overeat or binge just because you have taken medicines. Eating irresponsibly will only elevate blood sugar levels.

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Diabetes Complications

Did you know that constant high blood glucose levels actually damage and affect vital organs and parts of the body? That is why doctors and family members who care for you insist that you manage diabetes daily, constantly, and effectively, and avoid diabetes-induced coexisting chronic health conditions. Studies also suggest that people living with diabetes for a long time (15-20 years) often live with comorbid conditions arising due to diabetes. Let us explore the various body parts which are affected when diabetes is uncontrolled.  

Eyes

Due to uncontrolled diabetes especially in people living with type 1 diabetes and type 2 diabetes the nerves in the eyes get affected mostly because of the autoimmune-mediated responses which attack healthy nerve cells leading to various complications in the eyes such as diabetic retinopathy, glaucoma, diabetic macular edema, cataract and even serious conditions like vision loss.

  • Diabetic retinopathy - this is a condition in which the retinal blood vessels present in the eyes get affected they begin to excessively dilate (expand) and leak internal fluids present inside the cells. It can also cause internal bleeding, clots resulting in distorted vision, and even vision loss.
  • Glaucoma - is a condition in which the optic nerves which are connected to the brain cells get damaged due to pressure exerted inside the eye muscles. Glaucoma can occur in people without diabetes also but research claims that diabetes increases the risk of contracting glaucoma to manifolds when diabetes is not properly managed.
  • Cataract - is a common eye condition in which the natural lens of the eye gets a thin layer formation which results in poor vision. Studies suggest people with diabetes are 5 times more prone to have cataracts than people without diabetes
  • Diabetes macular edema - is a condition which is a progressive form of diabetes retinopathy characterized by inflammation (swelling) in the macula region present in the retina of the eyes.

Doctors highly recommend getting your eyes checked every six months if you have diabetes. Any symptoms such as dryness, excess watering, itching, redness, or distorted vision are not to be ignored and reported to your doctor without any further delay.

Oral Health

Uncontrolled and poorly managed diabetes not only leads to various nervous diseases but also invites infections, affecting membranes, gums, and enamel leading to various gums and tooth problems. The high glucose (sugar) levels pose a risk to your oral cavity which includes jaws, teeth, mouth area, tongue, and overall oral health. Bacterial and other pathogenic invasions in the mouth lead to following diseases such as gingivitis, periodontitis, candidiasis, pyorrhea, bad breath, and conditions like a dry or burning mouth.

You are recommended to maintain proper oral hygiene and brush twice a day at least to prevent plaque formation. Plaque is caused due to glucose present in the saliva mixed with food particles which coat and form a layer in our teeth. This layer is found to be bacteria-friendly and leads to diseases such as gingivitis and periodontitis. Additionally, you are cautioned to visit a dentist immediately if there are any wounds or ulcers which are not healing for more than 5-7 days. A routine six-monthly dentist checkup is a must for people living with diabetes.

Heart

People with diabetes are 3-4 times more at risk of developing heart diseases such as strokes and cardiovascular diseases than people without diabetes. This is because studies claim that those having diabetes (with special reference to type 2 people) often also have high blood pressure, high levels of cholesterol, high levels of triglycerides, and obesity which make them twice as susceptible to suffering from heart attacks or strokes.

Medical investigations are suggestive that in due course of time diabetes weakens the heart muscles, blood vessels, and nerves in the surrounding regions which eventually leads to heart diseases. Having uncontrolled diabetes (high erratic blood glucose levels) along with high triglycerides (fats) makes the chances of having heart-related problems.

Doctors recommend a complete change of lifestyle, eating habits, and cutting down on alcohol and tobacco intake. This will not only help you in keeping your blood glucose (sugar) levels in check but also prevent you from various heart ailments.

Kidney and bladder

High blood glucose (sugar) levels pose a great threat to our body's filtration system (kidneys and bladder). As we all know that our kidneys help us remove all the waste and toxins from our body and pass it out via urine. With uncontrolled diabetes, the blood vessels of the kidneys are damaged which in turn affects the way our body cleanses our system. Research strongly hints diabetics must keep a check on their overall renal (kidney) health to avoid partial or complete kidney damage. Kidney function tests and urine tests must be routinely performed to detect protein and malfunctioning of the kidneys and bladder. Kidney damage could be a life-threatening condition if not detected at an early stage. Hence you are recommended to visit a doctor and report symptoms like frequent urination, especially at the night, difficulty during urination, reduced urine output or pain during urination, unusual ankle swelling, and albumin or protein detection in the urine at the earliest.

Sexual Health

It may come as a surprise to many but people living with diabetes, which includes both men and women undergo significant changes in their sex hormones adversely affecting their sexual health. Diabetes is emerging to be responsible for a number of sexual health-related issues amongst men causing erectile dysfunction, impotence, loss of libido, premature ejaculation, and delayed ejaculation. Substantial studies claim that 50 % of men who have had diabetes for more than 10-15 years suffer from erectile dysfunction. Studies also hint that men with erectile dysfunction are often found to also have a heart-related disorder such as coronary heart disease.

Women, on the contrary, have been observed to suffer from hormonal disbalances with special reference to type 2 diabetes. Diseases such as PCOS (Polycystic ovarian syndrome) are often interconnected with diabetes which is one of the major reasons for female infertility. Some other common conditions arising due to diabetes are vaginal dryness, lack of sexual desires, pain during sex, and arousal difficulties.

Both men and women are highly encouraged to consult a doctor and ask for solutions to ease agonies related to sexual health. There have been recent advances in medical technology and products (medications and therapies) that help overcome conditions like erectile dysfunction and infertility. However, doctors advise good control of blood glucose levels along with regular exercising are recommended for diabetics to avoid sexual health complications such as erectile dysfunction and infertility. However, doctors advise good control of blood glucose levels along with regular exercising are recommended for diabetics to avoid sexual health complications.

Mental Health

Psychologists suggest, that people living with diabetes often undergo emotional turmoils due to long-term conditions and chronic symptoms. Their mental health and well-being are equally important just as their physical well-being. Research hints people who are happy and content with their lives have proven to achieve good control of diabetes versus people who are unhappy. Scientists claim that with the onset of diabetes feelings of anger, guilt, depression, low self-esteem, and anxiety set in.

Doctors recommend family members and caregivers extend emotional support and motivate people with diabetes to maintain blood sugar levels responsibly. And most importantly do not let diabetes come in the way of your life.

What is diabetes?

Diabetes is an umbrella term given to a group of conditions that exhibit high levels of glucose (sugar) in the bloodstream. Diabetes is a fast-approaching global epidemic with more than 73 million cases in India alone. The condition is often long-term and can lead to a number of chronic conditions if not treated and managed effectively on time. Diabetes, as believed earlier, is not a condition that triggers due to growing age, in fact, diabetes can affect anyone regardless of age and sex. However, some medical studies indicate that people over 40 years are more at risk and prone to develop diabetes than any other age group.

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References

  1. National Kidney foundation [Internet]. New York: National Kidney Foundation; Diabetes - A Major Risk Factor for Kidney Disease
  2. National Institute of Diabetes and Digestive and Kidney Diseases [internet]: US Department of Health and Human Services; Diabetes, Gum Disease, & Other Dental Problems
  3. National Health Service [internet]. UK; What is type 2 diabetes?
  4. Diabetes.co.uk [internet] Diabetes Digital Media Ltd; Causes of Diabetes.
  5. Diabetes.co.uk [internet] Diabetes Digital Media Ltd; Juvenile Diabetes.
  6. National Health Service [Internet]. UK; Overview - Gestational diabetes

Medicines for Diabetes

Medicines listed below are available for Diabetes. Please note that you should not take any medicines without doctor consultation. Taking any medicine without doctor's consultation can cause serious problems.

Lab Tests recommended for Diabetes

Number of tests are available for Diabetes. We have listed commonly prescribed tests below: